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Can a Florida Licensed Dental Hygienist Administer Anesthesia to Patients Without Supervision?

According to Florida Statute 466.023(1), Only dental hygienists may be delegated the task of removing calculus deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus and the task of performing root planing and curettage. In addition, dental hygienists may expose dental X-ray films, apply topical preventive or prophylactic agents, and perform all tasks delegable by the dentist in accordance with s. 466.024. The board by rule shall determine whether such functions shall be performed under the direct, indirect, or general supervision of the dentist.
 
Section (3) of the aforementioned Florida Statute, states that dental hygienists may, without supervision, provide educational programs, faculty or staff training programs, and authorized fluoride rinse programs; apply fluorides; instruct a patient in oral hygiene care; supervise the oral hygiene care of a patient; and perform other services that do not involve diagnosis or treatment of dental conditions and that are approved by rule of the board.
 
Section (5) of the aforementioned Florida Statute, states that Dental hygienists may, without supervision, perform dental charting as provided in s. 466.0235.
 
Section (5) of the aforementioned Florida Statute, states thatA dental hygienist may administer local anesthesia as provided in ss. 466.017 and 466.024.
 
Florida Statute 466.017(4) states that A dentist or dental hygienist who administers or employs the use of any form of anesthesia must possess a certification in either basic cardiopulmonary resuscitation for health professionals or advanced cardiac life support approved by the American Heart Association or the American Red Cross or an equivalent agency-sponsored course with recertification every 2 years. Each dental office which uses any form of anesthesia must have immediately available and in good working order such resuscitative equipment, oxygen, and other resuscitative drugs as are specified by rule of the board in order to manage possible adverse reactions.
 
Florida Statute 466.017(5) states that a dental hygienist under the direct supervision of a dentist may administer local anesthesia, including intraoral block anesthesia, soft tissue infiltration anesthesia, or both, to a non-sedated patient who is 18 years of age or older, if the following criteria are met:
 
(a) The dental hygienist has successfully completed a course in the administration of local anesthesia which is offered by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association or approved by the board. The course must include a minimum of 30 hours of didactic instruction and 30 hours of clinical experience, and instruction in:
 
1. Theory of pain control.
2. Selection-of-pain-control modalities.
3. Anatomy.
4. Neurophysiology.
5. Pharmacology of local anesthetics.
6. Pharmacology of vasoconstrictors.
7. Psychological aspects of pain control.
8. Systematic complications.
9. Techniques of maxillary anesthesia.
10. Techniques of mandibular anesthesia.
11. Infection control.
12. Medical emergencies involving local anesthesia.
 
(b) The dental hygienist presents evidence of current certification in basic or advanced cardiac life support.
(c) The dental hygienist possesses a valid certificate issued under subsection (6).
 
According to Florida Statute 466.003(1)(8) “Direct supervision” means supervision whereby a dentist diagnoses the condition to be treated, a dentist authorizes the procedure to be performed, a dentist remains on the premises while the procedures are performed, and a dentist approves the work performed before dismissal of the patient.
 
According to Florida Statute 466.024(1)(l) A dentist may delegate remediable tasks to a dental hygienist or dental assistant when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so defined by law or rule of the board. The board by rule shall designate which tasks are remediable and delegable, except that administering local anesthesia pursuant to s. 466.017(5) is  by law found to be remediable and delegable.
 
https://open.spotify.com/episode/1zBgOvMS6VEwUOSvjJ30ls?si=13b4b36a23a84683
 
 

Jamaal Jones Guest Speaks at Florida A&M University College of Law

On October 5th from 5-6p.m. Jamaal will be speaking with Florida A&M University College of Law students and others about the various job prospects available to aspiring health law attorneys.

In addition to working in private practice, students will find that they can work for health insurance companies, Federal and State Government Agencies, hospitals, as well as privately held and publicly traded companies. Mr. Jones will be joined by other panelists during this webinar.

 

Florida Legal Requirements for an Adult Family Care Home

Adult Family Care Homes are Agency for Health Care Administration (“AHCA” or Agency) licensed facilities that provide care to disabled adults and frail elders in a family-type living environment. These adults choose to live with an individual or a family in a private home. One key distinction between an Assisted Living Facility and an Adult Family Care Home (“AFCH”) is that the Provider must also live in the home, which can be owned or rented by that Provider. The home has to meet the local zoning requirements prior to obtaining the AHCA license. The intent behind the Adult Family Care Home Act is to allow for residents of AFCHs to remain as independent as possible and to avoid placement in a nursing home or other licensed facility.

 

AFCH means a full-time, family-type living arrangement, in a private home, under which a person who owns or rents the home provides room, board, and personal care, on a 24-hour basis, for no more than five disabled adults or frail elders who are not relatives. Personal care services includes individual assistance with or supervision of the activities or daily living and the self-determination of medication, and other similar services. A resident who requires 24-hour nursing supervision may not be retained in an AFCH unless such resident is an enrolled hospice patient and the resident’s continued residency is mutually agreeable to the resident. Certain types of family-type living arrangements are not required to be licensed as an AFCH.

 

Although no more than five adults may reside in the home, the licensed maximum capacity of each AFCH is based on the service needs of the residents and the capability of the provider to meet the needs of the residents. Any relative who lives in the adult family-care home and who is a disabled adult or frail elder must be included in that maximum resident count.

 

AFCH Requirements and License Restrictions

AFCHs must designate at least one licensed space for a resident receiving optional state supplementation. AFCHs are required to provide all residents: (1) room and board; (2) assistance necessary to perform the activities of dialing living; (3) assistance necessary to administer medication; (4) supervision of residents; (5) health monitoring; and (6) social and leisure activities.

 

Each AFCH license is effective for 2 years from the date of issuance or renewal. These licenses are non-transferable and is valid only for the provider named, the capacity stated, and the premises described on the license.

 

AFCHs may advertise but these accommodations and services may not be listed in the yellow pages under the heading of “nursing home” or “assisted living facility”. The advertisement must include the term Adult Family-Care Home and the license number.

 

Resident Requirements

In order to be admitted as a resident of an AFCH, an individual must be: (1) at least 18 years of age; (2) free from apparent signs and symptoms of any communicable disease; (3) capable of self-preservation in an emergency situation involving the immediate evacuation of the AFCH, with ambulation; (4) be able to perform, with supervision or assistance, activities of daily living; (5) not be a danger to self or others; (6) not require licensed professional mental health treatment on a 24-hour a day basis; and (7) not be bedridden, to name a few.

 

Prior to admission to an AFCH, an individual must have a face-to-face medical examination conducted by a licensed healthcare provider. Every year thereafter, or after a significant change, the resident must have a face-to-face medical examination.

 

Prior to, or at the time of admission, the AFCH must provide the resident or their representative with the following: (1) a copy of the AFCH house rules; (2) Resident’s Bill of Rights, and (3) the procedure for making complaints to AHCA, the Department of Children and Families, or the Florida Department of Health.

 

Each resident has a statutorily defined Bill of Rights that the AFCH is required to adhere to. Some of these rights include: (a) living in a safe and decent living environment, free from abuse and neglect; (b) keep and use the resident’s own clothes and other personal property in the resident’s immediate living quarters, so as to maintain individuality and personal dignity; (c) unrestricted private communication, including receiving and sending unopened correspondence, having access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum; (d) management or resident’s own financial affairs; (e) share a room with the resident’s spouse if both are residents of the home; (f) exercise of civil and religious liberties; (g) access to adequate and appropriate healthcare; and (i) to be free from chemical and physical restraints.

 

Each resident must enter into a residency agreement with the provider, which is to be executed prior to or on the date of admission. The residency agreement must be kept on file for five years after expiration of the agreement. Additionally, each residency agreement must specify the personal care and accommodations to be provided by the AFCH, the rate or charges, a requirement of at least 30 days’ notice before a rate increase, and any other provisions required by AHCA or any other governing agency.

 

A resident shall not be discharged without 30 days’ written notice stating reasons for the move or transfer. The only exception to this written notice requirement is if the resident’s health requires immediate relocation; resident’s behavior poses an imminent danger to self or others, significantly interferes with the orderly operation of the home, or is continually offensive to other residents; or if the AFCH had its license denied, revoked, or voluntarily surrendered its license.

 

Provider Requirements

An AFCH Provider must bet at least 21 years old, live in the home, complete the required training and be able to read, write and complete written materials involved in applying for an AFCH license and maintaining an AFCH.

 

Each AFCH Provider must complete training and education programs. Training and education programs must include information relating to the appropriateness of placement of residents in an AFCH; identifying and reporting abuse, neglect, and exploitation; monitoring the health of residents and identifying and meeting the special needs of disabled adults and frail elders.

 

Conclusion

There are many other considerations that one must take into account when deciding to run an AFCH. An AFCH has certain personal services and supervision requirements, incident reporting requirements, health monitoring, food service and nursing services requirements, relief person and training requirements, records requirements, general requirements, fire safety standards, and emergency procedure requirements that were not addressed in this blog post but are critically important to operating your AFCH. If you are interested in operating an AFCH I would encourage you contact an experience health law attorney at Jones Health Law to assist you with navigating these requirements and others.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Jamaal Jones is one of Legacy Magazine’s 40 Under 40 Black Leaders of Today and Tomorrow

Jamaal Jones has been selected as one of  Legacy Magazine’s 40 Under 40 Black Leaders of Today and Tomorrow for 2021. Mr. Jones is extremely honored to have been included in this list alongside other talented and accomplished professionals. He is the only Health Law attorney selected for inclusion in this year’s 40 under 40 list. Mr. Jones’ image is in the first column of the second row.

Here is a direct link to the Digital Copy of the Legacy Miami insert, which was included in August 22, 2021 edition of the Miami Herald and Sun Sentinel.

Jones Health Law Podcast: Episode 8 – Mental Health Discussion with Psychiatrist, Dr. Aminata Cisse

In this episode we are discussing Psychiatry with Aminata Cisse, M.D.! Dr. Cisse is a board-certified psychiatrist, specializing in mental health disorders. Her blog “Am Taar Wellness” offers an integrated approach of holistic healing and traditional psychiatric care, specifically tailored to the needs of women of the African Diaspora.  During our discussion, Dr. Cisse discussed a range of topics including: (1) the distinction between a Psychiatrist and Psychologist; (2) challenges of being a black psychiatrist and for those seeking treatment; (3) a typical day in the office and finding balance; (4) the media’s impact on our perception of psychiatry; (5) myths about psychiatry and pros/cons of being a psychiatrist; (5) the impact of social media on our mental health; (6) COVID-19 vaccine’s impact on our short-term and long-term mental health; and (7) is telepsychiatry less effective than in-person consultations, and more.

We touch on a wide range of topics in this podcast that I know you don’t want to miss. Don’t forget to listen and share with anyone that you think would be interested in listening as well.

Dr. Aminata Cisse can be reached at:

Instagram: @dr.amicisse

Email: amtaarwellness@gmail.com

Web: www.AmTaarWellness.com

What are Advance Directives and how they work in Florida?

It’s not unusual for you or a family member to find oneself in a medical emergency where certain critical decisions pertaining to one’s health have to be made expediently. Often times people who are in emergency situations are incapacitated, whether due to legal incapacity (i.e. age), mental health or physical limitations, and are unable to make decisions for themselves. What ensues is a battle between loved ones about who has legal right to make certain decisions about your health. Out of nowhere comes an estranged spouse or distant relative who wants to make decisions that other family members feel they shouldn’t be making but are legally entitled to make. To avoid these scenarios, we encourage our clients to prepare advance directives. Florida Advance Directives are a combination of forms that are used in the event that an individual is physically or mentally incapable of giving consent. Individuals may complete an advance directive, which may include information about his or her living will, health care surrogates, and health care proxies. Each advance directive addresses medical and legal conditions that provide appropriate planned care to the individual.

 

Completing an Advance Directive

The following is a non-exhaustive list of the general principles of advance directives:

  • The individual completing a directive form must be a competent adult.
  • An advance directive completed in another state is applicable in Florida as long as it complies with the law of the state in which it was executed or with Florida law.
  • A competent adult may make an advance directive instructing their physician as to their wishes regarding their medical care, which may include instructions to provide, withhold, or withdraw life prolonging procedures.
  • A principal may empower a surrogate or health care proxy to make health care decisions for them on their advance directive.
  • The principal may amend or revoke an advance directive or the decisions of the health care surrogate or proxy at any time as long as the principal is competent.

 

Sections of Advance Directives in Florida

 

Living Will

Any competent adult may create a living will in respect to the principal’s desires regarding medical treatment should the principal become incompetent or incapacitated. The will must be signed by the principal in the presence of two witnesses. The witnesses cannot be the spouse or a blood relative of the principal. If the principal is physically unable to sign the will, a witness may subscribe the principal’s signature in the principal’s presence and direction as per Fla. Stat. §765.302. A living will may also be an oral statement made by the principal however the statute does not offer further guidance on how an oral living will is created.

 

Health Care Surrogate

Apart from living wills, an advance directive may consist of a health care surrogate. Florida allows a principal to appoint a person, such as a health care surrogate, to act as their healthcare decision maker. A healthcare surrogate must be a competent adult who has been designated by the principal, who must also be a competent adult, to make health care decisions on behalf of the principal. Unless the advance directive states a termination, the designations of the health care surrogate remain in effect unless revoked by the principal.

 

Health Care Proxy

A Health Care Proxy is a competent adult who has not been expressly designated by the principal to make health care decisions for them but is statutorily authorized in the event of the principal’s incapacity. In no particular order of priority, this is a non-exhaustive list of individuals who may act as a health care proxy for the principal:

  • The principals spouse
  • A judicially appointed guardian authorized to consent to medical treatment
  • An adult child
  • An adult sibling
  • A close personal friend of the principal
  • A license clinical social worker

 

End of Life Decisions Made through Living Will, Surrogate or Proxy

Florida law allows life-prolonging procedures to be withheld or withdrawn under the terms of a living will. As per Fla. Stat. §765.101(12), Florida defines life-prolonging procedures to include any medical procedure, treatment, or intervention, which sustains or supplants a spontaneous vital function. To determine whether life-prolonging procedures have to be withdrawn or withheld by a living will, surrogate, or proxy, the principal must be found to suffer from a terminal condition, end stage condition, or a persistent vegetative state. As per Fla. Stat. §765.304(1), the principal’s primary physician may proceed in life-prolonging procedures if the principal has not designated a surrogate to execute their wishes concerning life-prolonging procedures.

 

Do Not Resuscitate Order (DOH Form 1896)

There is a form drafted by the Florida Department of Health that is completed by a person’s physician to indicate that the person does not want to be resuscitated in case of a respiratory or cardiac arrest. In order for the form to be effective it must be printed on yellow paper. This form does not need to be witnessed and it does not require formalities. The principal or their health care surrogate/proxy and their physician must sign the form. Health care facilities and emergency responders will honor the DNRO form.

It should be clear why creating advance directives are essential and should become part of your estate planning. You do not want someone making decisions about your health care if you would prefer someone else to make those decisions on your behalf. Typically, if you select a certain individual to make decisions for you its because they are familiar with your wishes and would be willing to carry them out regardless of their own personal beliefs and emotional state. If you would like to learn more about advance directives, please feel free to contact one of our attorneys.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Physician Assistants Scope of Practice Expansion in Florida

By: Arlette Rodriguez

Just as is the case with Advanced Practice Registered Nurses, the Florida Legislature has recognized that Physician Assistants (PA) are capable of performing certain health care activities that they were previously prohibited from performing. The changes are largely administrative and does not significantly increase the independent clinical services that they may provide to a patient. On June 29, 2021, the governor approved House Bill 431, which expands the scope of practice for Physician Assistants. The provisions set forth in the House Bill 431 took effect on July 1, 2021.

The following is a non-exhaustive list of some of the changes that PA can expect under the new law:

 

  • Prescribe psychiatric mental health-controlled substances to minors (under certain circumstances);
  • Supervise medical assistants;
  • Sign and certify documents that previously required a physician’s signature, such as Baker Act commitments, do-not-resuscitate orders, school physicals, and death certificates;
  • Bill directly to the insurance companies and receive payments for their provided services, and;
  • Authorize doctors to supervise up to ten physician assistants; (previously it was limited to four).

 

Notably, the law does not permit PA to sign for medical marijuana certification, workers compensation medical examinations required to determine maximum medical improvement, and impairment ratings. Florida PA are bound by the requirements contained in Florida Statute §§458.347 and 459.022.

One of the more noteworthy changes to the law is that it deletes the requirement that a physician assistant must inform his or her patients that they have the right to see a physician before the physician assistant prescribes or dispenses a prescription (amendment to Fla. Stat. §458.347(4)(e)(1)) and Fla. Admin. Code R. 64B8-30.012.  Also, physician assistants are now authorized to procure drugs and medical devices and revising the requirements for a certain formulary (amendment to Fla. Stat. §458.347(4)(f)(1) and Fla. Admin. Code R. 64B8-30.008).

 

Certificate of Completion of a Board Physician Assistant

Under the House Bill 431, a physician assistant applicant who has graduated after December 31, 2020 must have received a master’s degree in accordance with the Accreditation Review Commission on Education for the Physician Assistant. For an applicant who graduated on or before December 31, 2020, one must have received a bachelor’s or master’s degree from an approved program.

An applicant who graduated before July 1, 1994, must have graduated from an approved program of instruction in primary health care or surgery. An applicant who graduated before July 1, 1983, must have received a certification as a PA from the board.

Finally, the bill further authorizes the board to grant a license to an applicant who does not meet the above specified educational requirements, but who has passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants before 1986.

The formulary changes in House Bill 431 will provide Physician Assistants the tools they need to reach a broader patient platform and by allowing doctors to supervise more physician assistants at a time, this will encourage hospitals and health care facilities to hire more physician assistants. House Bill 431 will bring many changes to physician assistants and we hope that you may benefit from these changes.

 

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.